Lidocaine-Prilocaine Cream versus Placebo in Conjunction with Lidocaine Injection for Pain Relief during Episiotomy Repair after Normal Vaginal Delivery
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Abstract
Objective: To study the efficacy of lidocaine-prilocaine cream versus placebo in conjunction with lidocaine injection in relieving pain during episiotomy repair.
Materials and Methods: Postpartum women who underwent restrictive episiotomy with second-degree perineal tears from August 2023 to February 2024 were randomly allocated into two groups. In the intervention group, lidocaine-prilocaine cream was applied around the episiotomy wound in conjunction with lidocaine injection, while in the control group, placebo cream was applied instead. The primary outcome was pain intensity during episiotomy repair using a 10-cm visual analogue scale (VAS).
Results: Ninety women were randomly assigned into two groups (45 in each group). Pain score during episiotomy repair in the lidocaine-prilocaine cream group was significantly lower than the control group. Pain score during lidocaine injection in the lidocaine-prilocaine cream group was significantly lower compared to the control group (2.45 ± 2.49 vs. 3.71 ± 2.73; mean difference (MD) -1.26, 95% CI: -2.07 to -0.46, p 0.002). Pain scores during perineal muscle repair and perineal skin repair in the lidocaine-prilocaine cream group were significantly lower than the control group (1.95 ± 2.13 vs. 3.13 ± 2.34; MD -1.19, 95% CI: -2.11 to -0.27, p 0.012 and 1.87 ± 2.12 vs. 3.82 ± 2.86; MD -1.95, 95% CI: -2.95 to -0.95, p < 0.001, respectively). Perineal wound complications were not significantly different between groups (p 0.556). No adverse reactions were found.
Conclusion: Lidocaine-prilocaine cream in conjunction with lidocaine injection effectively reduced pain during episiotomy repair without adverse reaction.
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References
References
McCandlish R, Bowler U, van Asten H, Berridge G, Winter C, Sames L, et al. A randomised controlled trial of care of the perineum during second stage of normal labour. BJOG Int J Obstet Gynaecol. 1998;105(12):1262–72.
Thiagamoorthy G, Johnson A, Thakar R, Sultan AH. National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecology J. 2014 Dec 1;25(12):1621–7.
Lappen JR, Gossett DR. Changes in episiotomy practice: evidence-based medicine in action. Expert Rev Obstet Gynecol. 2010 May 1;5(3):301–9.
Sanders J, Peters TJ, Campbell R. Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice. Midwifery. 2005 Jun 1;21(2):154–60.
Dahlen HG, Homer CSE, Cooke M, Upton AM, Nunn RA, Brodrick BS. “Soothing the ring of fire”: Australian women’s and midwives’ experiences of using perineal warm packs in the second stage of labour. Midwifery. 2009 Apr;25(2):e39-48.
Eshkevari L, Trout KK, Damore J. Management of postpartum pain. J Midwifery Womens Health. 2013;58(6):622–31.
Kargar R, Aghazadeh-Nainie A, Khoddami-Vishteh HR. Comparison of the Effects of Lidocaine Prilocaine Cream (EMLA) and Lidocaine Injection on Reduction of Perineal Pain During Perineum Repair in Normal Vaginal Delivery. J Fam Reprod Health. 2016 Mar;10(1):21–6.
Topical Lidocaine- Prilocaine Cream Versus Lignocaine Infiltration For Episiotomy Repair: A Randomized Clinical Trial. J Clin Res Gov [Internet]. 2013 [cited 2024 Sep 12]; Available from: http://index.sciencepub.se/ojs/index.php/JCRG/article/view/59
Moradi Z, Kokabi R, Ahrari F. Comparison of the Effects of Lidocaine-Prilocaine Cream and Lidocaine Injection on the Reduction of Perineal Pain While Doing and Repairing Episiotomy in Natural Vaginal Delivery: Randomized Clinical Trial. Anesthesiol Pain Med. 2019 Apr 24;9(3):e90207.
Jorge LL, Feres CC, Teles VE. Topical preparations for pain relief: efficacy and patient adherence. J Pain Res. 2010 Dec 20;4:11–24.
Walker SM. Neonatal pain. Paediatr Anaesth. 2014 Jan;24(1):39–48.
Franchi M, Cromi A, Scarperi S, Gaudino F, Siesto G, Ghezzi F. Comparison between lidocaine-prilocaine cream (EMLA) and mepivacaine infiltration for pain relief during perineal repair after childbirth: a randomized trial. Am J Obstet Gynecol. 2009 Aug;201(2):186.e1-5.
Friedman PM, Mafong EA, Friedman ES, Geronemus RG. Topical anesthetics update: EMLA and beyond. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2001 Dec;27(12):1019–26.
Buckley MM, Benfield P. Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics (EMLA). Drugs. 1993 Jul;46(1):126–51.
Drugs.com [Internet]. [cited 2024 Sep 12]. EMLA: Package Insert / Prescribing Information. Available from: https://www.drugs.com/pro/emla.html
Lüllmann B, Leonhardt J, Metzelder M, Hoy L, Gerr H, Linderkamp C, et al. Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLATM. Eur J Pediatr. 2010 Dec 1;169(12):1465–9.
Shavit I, Hadash A, Knaani-Levinz H, Shachor-Meyouhas Y, Kassis I. Lidocaine-based topical anesthetic with disinfectant (LidoDin) versus EMLA for venipuncture: a randomized controlled trial. Clin J Pain. 2009 Oct;25(8):711–4.
Greveling K, Prens E p., Liu L, van Doorn M b. a. Non-invasive anaesthetic methods for dermatological laser procedures: a systematic review. J Eur Acad Dermatol Venereol. 2017;31(7):1096–110.
Zilbert A. Topical anesthesia for minor gynecological procedures: a review. Obstet Gynecol Surv. 2002 Mar;57(3):171–8.
Hilliges M. Nociception in Mucosa of Sexual Organs. In: Gebhart GF, Schmidt RF, editors. Encyclopedia of Pain [Internet]. Berlin, Heidelberg: Springer; 2013 [cited 2024 Sep 13]. p. 2171–2. Available from: https://doi.org/10.1007/978-3-642-28753-4_2743
Abbas A, Hafiz H, Abdelhafez A, Michael A, Ismail A. Topical lidocaine-prilocaine cream versus lidocaine infiltration for pain relief during repair of perineal tears after vaginal delivery: randomized clinical trial. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2018 Jan 15;32:1–181.